Community health worker promotions increase uptake of long-acting reversible contraception in Rwanda
Year: 2019
Type: article
Abstract: BACKGROUND: We coordinated community health worker (CHW) promotions with training and support of government clinic nurses to increase uptake of long-acting reversible contraception (LARC), specifically the copper intrauterine device (IUD) and the hormonal implant, in Kigali, Rwanda. METHODS: From August 2015 to September 2016, CHW provided fertility goal-based family planning counseling focused on LARC methods, engaged couples in family planning counseling, and provided written referrals to clients expressing interest in LARC methods. Simultaneously, we provided didactic and practical training to clinic nurses on LARC insertion and removal. We evaluated: 1) aggregate pre- versus post-implementation LARC uptake as a function of CHW promotions, and 2) demographic factors associated with LARC uptake among women responding to CHW referrals. RESULTS: 7712 referrals were delivered by 184 CHW affiliated with eight government clinics resulting in 6072 family planning clinic visits (79% referral uptake). 95% of clinic visits resulted in LARC uptake (16% copper IUD, 79% hormonal implant). The monthly average for IUD insertions doubled from 29 prior to service implementation to 61 after (p < 0.0001), and the monthly average for implant insertions increased from 109 to 309 (p < 0.0001). In adjusted analyses, LARC uptake was associated (p < 0.05) with the CHW referral being issued to the couple (versus the woman alone, adjusted odds ratio, aOR = 2.6), having more children (aOR = 1.3), desiring more children (aOR = 0.8), and having a religious affiliation (aOR = 2.9 Protestant, aOR = 3.1 Catholic, aOR = 2.5 Muslim each versus none/other). Implant versus non-LARC uptake was associated with having little or no education; meanwhile, having higher education was associated with IUD versus implant uptake. CONCLUSIONS: Fertility goal-based and couple-focused family planning counseling delivered by CHW, coupled with LARC training and support of nursing staff, substantially increased uptake of LARC methods.
Source: Reproductive Health
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,570
Funders: United States Agency for International Development, International AIDS Vaccine Initiative, National Institutes of Health, Centers for Disease Control and Prevention, National Institute of Mental Health, National Institute of Allergy and Infectious Diseases, Fogarty International Center, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: VCT with Primary and Concurrent Partners to Prevent HIV Transmission , G1024601419, Family Planning Promotion in HIV Infected Zambians, PROJECT SAN FRANCISCO CENTER OF EXCELLENCE FOR THE EXPANSION OF CHCT IN RWANDA AN, IUD, implant, and condoms: sexual and perinatal HIV prevention in Rwandan couples, HETEROSEXUAL TRANSMISSION AND THE NATURAL HISTORY OF HIV, G4217634486, HETEROSEXUAL TRANSMISSION AND THE NATURAL HISTORY OF HIV, G4800845989, RAWANDA ZAMBIA HIV RESEARCH GROUP CENTER OF EXCELENCE FOR THE EXPANSION OF CHCT S, Emory AIDS International Training and Research Program, Couples HIV Counseling & Testing in two African capitals, G8614701313, Center for AIDS Research at Emory University
OpenAlex ID: W2948385624